# Behavioral or Solifenacin Therapy for Urinary Symptoms in Parkinson Disease

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

The number of persons with Parkinson Disease (PD) in the United States is expected to double by 2030 as the
population ages. Importantly, this increase in the prevalence of PD will have greater impact within the
Department of Veterans Affairs (VA) because the Veteran population is older than the general population and
Veterans with PD are more likely than those without PD to rely solely on VA for their health care. While PD is
often characterized by the motor symptoms of the disease (tremor, bradykinesia, rigidity), non-motor symptoms
such as urinary symptoms correlate more closely with impaired well-being as the disease progresses.
However, the impact of urinary symptoms in PD extends beyond worsened well-being. The urinary symptoms
of overactive bladder (OAB), including urgency, frequency, and nocturia, with or without urinary incontinence,
are the most common urinary symptoms of PD. OAB symptoms are associated with falls (a cause of
increased mortality in PD), with spouse/caregiver stress, and, ultimately with institutionalization, thus it is
critical that we optimize the care of urinary symptoms for Veterans with PD.
 Several studies suggest abnormal central nervous system processing of sensory input from bladder
afferent nerves contributes to OAB symptoms in PD, possibly because of delayed recognition of bladder
fullness. This mirrors findings in non-PD populations with OAB. In the non-PD OAB population, pelvic floor
muscle contractions diminish bladder muscle contraction and recent evidence demonstrates that behavioral
training with pelvic floor muscle exercises improves the cortical integration of bladder afferent signals. Pelvic
floor muscle exercise-based behavioral therapy for OAB symptoms requires individuals to learn a motor skill
and implement an adaptive behavioral strategy to delay the need to void. Because of its effectiveness
compared to drug therapy, pelvic floor muscle exercise-based behavioral therapy is recommended first-line in
men and women with OAB who do not have PD. However, the most recent clinical guidelines for the treatment
of urinary symptoms in PD recommend treatment with anticholinergic drugs. While some anticholinergic drugs
are effective in reducing symptoms of OAB, it is important to note that there is a glaring lack of an empirical
evidence base to promote these drugs in the setting of PD given that they add to the anticholinergic burden of
antiparkinsonian therapy, and may worsen the cognitive and autonomic burdens of the illness. Therefore,
randomized controlled trials (RCTs) are needed to optimize treatment paradigms for urinary symptoms in PD.
 We propose a three-site, RCT conducted at the Atlanta (lead site), Birmingham and Richmond VA's to
establish non-inferiority of pelvic floor muscle exercise-based behavioral therapy compared to drug therapy for
OAB symptoms in adults with PD. Groups will be stratified by OAB symptom severity, PD motor symptom
severity, gender, and site. We will randomize 90 particip...

## Key facts

- **NIH application ID:** 10111368
- **Project number:** 5I01RX002293-04
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Elizabeth Camille Vaughan
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10111368

## Citation

> US National Institutes of Health, RePORTER application 10111368, Behavioral or Solifenacin Therapy for Urinary Symptoms in Parkinson Disease (5I01RX002293-04). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10111368. Licensed CC0.

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